Hospital Emergency Research Articles

Knowledge and Awareness of Mothers of Asthmatic Children and Its Impact on Asthma Control: A Cross-Sectional Study From Qassim Region, Saudi Arabia.

Introduction Asthma, a common chronic airway disorder, presents challenges in diagnosis and management, particularly in children. Triggers include allergens and pollutants, necessitating lifestyle modifications and pharmacological treatments. Severe cases require tailored management. International guidelines provide stepwise approaches, while the Saudi Thoracic Society offers comprehensive recommendations, emphasizing gradual treatment phases and thorough clinical assessment. This study aimed to evaluate the knowledge and awareness levels among mothers of asthmatic children in Qassim region, Saudi Arabia. Methodology This cross-sectional study was conducted among 422 mothers with asthmatic children at primary healthcare centers in Qassim, Saudi Arabia. Mothers' knowledge of asthma was assessed using an online questionnaire. Participants were selected via a convenient non-probability sampling technique. Data was cleaned in Excel and analyzed using IBMSPSSStatistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York, United States). Participants were selected via a convenient non-probability sampling technique. Necessary statistical tests like Chi-square and Fisher'sexact test were applied. Results Our study involved 422 mothers of asthmatic children in Saudi Arabia. Most participants were aged 35-44 years (50.7%) and Saudi nationals (92.2%), with 88.2% having one asthmatic child. Regarding awareness, exposure to air pollution (97.9%) and cigarettes (93.4%) were well-recognized factors. Pediatricians (50.5%) and family physicians (42.2%) were primary information sources. Concerning attitudes, most mothers disagreed with the harmful effects of inhalers (82.5%-92.7%) and advocated for avoiding smoking near asthmatic children (94.8%). Our study revealed that 94.5%of mothers of asthmatic children possessed a good level of knowledge about asthma in their children, while 5.5%demonstrated a low level of knowledge. Notably, mothers with good knowledge levels reported fewer emergency room visits (p=0.011) and hospitalizations (p=0.001). Predictors of good-level knowledge included higher education (adjusted odds ratio (AOR) =4.080, p=0.007) and absence of smoking relatives (AOR =0.222, p=0.005), while pet ownership was associated with lower knowledge (AOR =0.257, p=0.030). Conclusion Our study underscores the importance of maternal knowledge in pediatric asthma management. Good awareness levels were observed regarding key risk factors and appropriate attitudes toward medication use. Higher education and absence of smoking relatives were significant predictors of mothers' knowledge of the disease.

Implementing DPYD/UGT1A1testing to prevent treatment related adverse events (TRAE) in patients with gastrointestinal (GI) cancer: Results of a pragmatic implementation trial.

10599 Background: Fluoropyrimidines (FP), 5-FU and capecitabine, are standard treatments for many GI cancers. Irinotecan may be used with FPs in both the curative and palliative settings. 30-40% of patients experience severe TRAEs which can lead to treatment interruption and hospitalization. TRAE risk is higher in patients with pharmacogenetic variants in DPYD and/or UGT1A1. Methods: This is a non-randomized, open-label implementation study at 3 cancer care sites within an academic health system to determine feasibility of integrating DPYD/UGT1A1 testing into clinical care (IMPACT-GI; NCT#04736472). Test ordering and discrete variant resulting were available within the Electronic Health Record. The lab detected 5 DPYD variants with reduced or no function (c.1905+1G>A, c.2846A>T, c.1679T>G, c.1236G>A, c.557A>G) and 2 UGT1A1 (*6, *28) alleles. Patients with a GI cancer initiating treatment with 5-FU, capecitabine, or irinotecan underwent testing along with preemptive chemotherapy dose modifications. Carriers of 1 DPYD variant (i.e., intermediate metabolizers [IM]) and UGT1A1 homozygous carriers (i.e., poor metabolizers [PM]) were recommended a 50% and 30% dose reduction, respectively. The primary endpoints were feasibility (proportion of results available prior to cycle 1) and fidelity (genotype concordant dose modifications). Secondary endpoints included severe TRAE (requiring emergency room visit or hospitalization) comparing variant carriers vs. wildtype over the first 6 cycles. Results: From 3/2021- 12/2022, 224 patients received testing (54% male, 74% White, 18% Black, mean age 62 ±17 years. The most common diagnoses were 47% colorectal and 30% pancreatic cancers. The median lab turnaround time was 10 (IQR 9-13) calendar days with 57.2% of results available prior to cycle 1. Results available prior to cycle 1 varied by distance to lab (64.7% near sites vs. 32.7% far site, p<0.001). We identified 7 (3%) DPYD intermediate metabolizers (IM) and 33 (15%) UGT1A1 poor metabolizers (PM). Four (2%) patients carried a variant in both DPYD and UGT1A1. Chemotherapies were preemptively dose reduced for 6 of 7 DPYD carriers receiving FP and 5 of 8 UGT1A1 PMs receiving irinotecan. 2 (28%) DPYD carriers vs. 71 (33%) wildtype carriers had a severe TRAE. 4 (50%) UGT1A1 PMs vs. 11 (36%) UGT1A1 wildtype carriers experienced a severe TRAE. Conclusions: DPYD/UGT1A1 testing is feasible with oncology providers following the genotype guided dose reductions when results were available prior to cycle 1. Pretreatment DPYD/UGT1A1 testing in conjunction with preemptive dose reductions resulted a similar proportion of severe TRAE as compared with wild-type patients. Further workflow modifications are required to decrease test turnaround time to ensure results are available prior to chemotherapy initiation. Clinical trial information: NCT04736472 .

The burden of significant pain in the cirrhosis population: Risk factors, analgesic use, and impact on health care utilization and clinical outcomes.

We aimed to characterize pain and analgesic use in a large contemporary cohort of patients with cirrhosis and to associate pain with unplanned health care utilization and clinical outcomes in this population. We included all patients with cirrhosis seen in UCSF hepatology clinics from 2013 to 2020. Pain severity and location were determined using documented pain scores at the initial visit; "significant pain" was defined as moderate or severe using established cutoffs. Demographic, clinical, and medication data were abstracted from electronic medical records. Associations between significant pain and our primary outcome of 1-year unplanned health care utilization (ie, emergency department visit or hospitalization) and our secondary outcomes of mortality and liver transplantation were explored in multivariable models. Among 5333 patients with cirrhosis, 32% had a nonzero pain score at their initial visit and 25% had significant (ie moderate/severe) pain. Sixty percent of patients with significant pain used ≥1 analgesic; 34% used opioids. Patients with cirrhosis with significant pain had similar Model for End-Stage Liver Disease-Sodium scores (14 vs. 13), but higher rates of decompensation (65% vs. 55%). The most common pain location was the abdomen (44%). Patients with abdominal pain, compared to pain in other locations, were more likely to have decompensation (72% vs. 56%). Significant pain was independently associated with unplanned health care utilization (adjusted odds ratio: 1.3, 95% CI: 1.1-1.5) and mortality (adjusted hazard ratio: 1.4, 95% CI: 1.2-1.6). Pain among patients with cirrhosis is often not well-controlled despite analgesic use, and significant pain is associated with unplanned health care utilization and mortality in this population. Effectively identifying and treating pain are essential in reducing costs and improving quality of life and outcomes among patients with cirrhosis.

Management of Adults With Bacterial Meningitis in the Emergency Department.

The Leicester Royal Infirmary Emergency Department is one of the largest single-site Emergency Departments in the UK. We evaluated the department's management of bacterial meningitis. The current national guideline recommends that all patients presenting with suspected bacterial meningitis receive antibiotics within one hour. A survey of 100 clinicians (Consultants, Registrars, House Officers, and Advanced Clinical Practitioners) working in the Emergency Department was performed to determine the awareness of the guidelines and a retrospective examination of case notes for patients who presented at the Leicester Royal Infirmary Emergency Department with suspected meningitis was carried out between May 1, 2022, and May 1, 2023. A random sample of 30 patients was drawn from the department's database of 190 patients, identified through discharge coding summaries. Nine (25%) of the prescribers knew of the guidelines for managing meningitis, and six (16.7%) had utilised the hospital guidelines. Thirty-three (91.7%) prescribers acknowledged the importance of administering steroids to patients suspected of having bacterial meningitis (excluding those displaying signs of meningococcal sepsis, such as a rash). However, only seven (23%) of patients received this treatment. Additionally, only one (3.3%) patient was documented as having received a dose within the first hour of presentation. The timely diagnosis and administration of appropriate antibiotic therapy are pivotal elements in managing bacterial meningitis. As a result, we designed a checklist to facilitate the effective management of meningitis within the department by increasing awareness of the guidelines and making the critical principles of suspected meningitis management more accessible.

Identifying key health system components associated with improved outcomes to inform the re-configuration of services for adults with rare autoimmune rheumatic diseases: a mixed-methods study

Adults with rare autoimmune rheumatic diseases face unique challenges and struggles to navigate health-care systems designed to manage common conditions. Evidence to inform an optimal service framework for their care is scarce. Using systemic vasculitis as an exemplar, we aimed to identify and explain the key service components underpinning effective care for rare diseases. In this mixed-methods study, data were collected as part of a survey of vasculitis service providers across the UK and Ireland, interviews with patients, and from organisational case studies to identify key service components that enable good care. The association between these components and patient outcomes (eg, serious infections, mortality) and provider outcomes (eg, emergency hospital admissions) were examined in a population-based data linkage study using routine health-care data obtained from patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis from national health datasets in Scotland. We did univariable and multivariable analyses using Bayesian poisson and negative binomial regression to estimate incident rate ratios (IRRs), and Cox proportional hazards models to estimate hazard ratios (HRs). People with lived experiences were involved in the research and writing process. Good care was characterised by service components that supported timely access to services, integrated care, and expertise. In 1420 patients with ANCA-associated vasculitis identified from national health datasets, service-reported average waiting times for new patients of less than 1 week were associated with fewer serious infections (IRR 0·70 [95% credibility interval 0·55-0·88]) and fewer emergency hospital admissions (0·78 [0·68-0·92]). Nurse-led advice lines were associated with fewer serious infections (0·76 [0·58-0·93]) and fewer emergency hospital admissions (0·85 [0·74-0·96]). Average waiting times for new patients of less than 1 week were also associated with reduced mortality (HR 0·59 [95% credibility interval 0·37-0·93]). Cohorted clinics, nurse-led clinics, and specialist vasculitis multi-disciplinary team meetings were associated with fewer serious infections (IRR 0·75 [0·59-0·96] for cohorted clinics; 0·65 [0·39-0·84] for nurse-led clinics; 0·72 [0·57-0·90] for specialist vasculitis multi-disciplinary team meetings) and emergency hospital admissions (0·81 [0·71-0·91]; 0·75 [0·65-0·94]; 0·86 [0·75-0·96]). Key components were characterised by their ability to overcome professional tensions between specialties. Key service components associated with important health outcomes and underpinning factors were identified to inform initiatives to improve the design, delivery, and effectiveness of health-care models for rare autoimmune rheumatic diseases. Versus Arthritis.

Drug-Drug Interactions and Their Association with Adverse Health Outcomes in the Older Community-Dwelling Population: A Prospective Cohort Study.

Evidence on associations between drug-drug interactions (DDIs) and health outcomes in the older community-dwelling population is limited. We estimate potentially clinically important DDI prevalence and examine the association between DDIs and (1) adverse drug events (ADEs), (2) emergency hospital attendance and (3) health-related quality of life (HRQoL) in an older community-dwelling population in Ireland. This is a prospective cohort study of community-dwelling older adults (N = 904) aged ≥ 70 years from 15 general practices in Ireland recruited in 2010 (wave-1) and followed-up over 2 years (wave-2; 2012-2013), with linked national pharmacy claims data. Individuals dispensed two or more drugs (wave-1: N = 842; wave-2: N = 763) were included. DDI prevalence at baseline, follow-up and 6 months prior to each health outcome was estimated. Multi-level regression was used to model the association between DDI-exposure and health outcomes at follow-up. DDI prevalence, adjusted incidence-rate ratios (aIRR), adjusted odds ratios (aOR), β coefficients and robust standard error (RSE) from multi-level regression analyses, and 95% confidence intervals (CIs) are reported. At wave-1, n = 196 (23.3% [95% CI 20.5-26.3]), individuals were potentially exposed to ≥ 1 DDI, increasing to n = 345 (45.2% [41.7-48.9]) at wave-2. At 2-year follow-up, the median number of ADEs was 3 (interquartile range [IQR 2-5]); 229 (30.1%) had ≥ 1 emergency hospital attendance, and the mean EQ-5D was 0.74 (± 0.23). Evidence for the association between DDI-exposure and emergency hospital attendance at follow-up was lacking (aOR = 1.38 [0.42-4.53]). DDI-exposure was associated with an increasing number of ADEs (aIRR = 1.26 [1.03-1.55]), and decreasing EQ-5D utility (β = - 0.07, [-0.11 to -0.04], RSE = 0.02). Aspirin-warfarin, clarithromycin-prednisolone, amiodarone-furosemide, clarithromycin-salbutamol, rosuvastatin-warfarin, amiodarone-bisoprolol, and aspirin-nicorandil were common DDIs 6 months preceding these health outcomes. We found a two-fold increase in DDI prevalence between wave 1 and 2. DDI exposure was associated with increasing ADEs and declining HRQoL at 2-year follow-up. Common DDIs involved anticoagulants, cardiovascular and antimicrobial drugs, which should be targeted for medicine optimisation.

Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection

Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.

Blood Link

Abstract: In the face of medical emergencies, the rapid and reliable delivery of blood to hospitals can be a matter of life and death. This project presents "BloodLink," a comprehensive solution that leverages modern web technologies and drone delivery systems to streamline the blood supply chain between blood banks and hospitals. The front-end of the system is developed using HTML, CSS, and JavaScript, ensuring a user-friendly interface for hospital staff to post blood group requirements. The backend is powered by the Flask framework of Python, facilitating robust and scalable server-side operations. Utilizing the Google Maps API, our platform dynamically identifies and displays the nearest blood banks in response to hospital requests, ensuring timely and accurate information. For critical situations requiring immediate action, we have integrated an innovative drone delivery system designed to expedite the transportation of blood to the requesting hospitals. The software development phase of the project is complete, and efforts are currently focused on the practical design and implementation of the drone system. This paper details the architecture, development process, and potential impact of "BloodLink" in revolutionizing emergency blood delivery and hospital blood bank coordination.

The effect of dementia on patterns of healthcare use in older adults with diabetes.

For persons with diabetes, incidence of dementia has been associated with increased hospitalization; however, little is known about healthcare use preceding and following incident dementia. We describe healthcare utilization in the 3 years pre- and post-incident dementia among older adults with diabetes. We used the National Health and Aging Trends Study (NHATS) linked to Medicare fee-for-service claims from 2011 to 2018. We included community-dwelling adults ≥65 years who had diabetes without dementia. We matched older adults with dementia (identified with validated NHATS algorithm) at the year of incident dementia to controls using coarsened exact matching. We examined annual outpatient visits, emergency department (ED) visits, hospitalization, and post-acute skilled nursing facility (SNF) use 3 years preceding and 3 years following dementia onset. We included 195 older adults with diabetes with incident dementia and 1107 controls. Groups had a similar age (81.6 vs 81.7 years) and were 56.4% female. Persons with dementia were more likely to be of minority racial and ethnic groups (26.7% vs 21.3% Black, non-Hispanic, 15.3% vs 6.7% other race or Hispanic). We observed a larger decrease in outpatient visits among persons with dementia, primarily due to decreasing specialty visits (mean outpatient visits: 3 years pre-dementia/matching 6.8 (SD 2.6) dementia vs 6.4 (SD 2.6) controls, p < 0.01 to 3 years post-dementia/matching 4.6 (SD 2.3) dementia vs 5.5 (SD 2.7) controls, p < 0.01). Hospitalization, ED visits, and post-acute SNF use were higher for persons with dementia and rose in both groups (e.g., ED visits 3 years pre-dementia/matching 3.9 (SD 5.4) dementia vs 2.2 (SD 4.8) controls, p < 0.001; 3 years post-dementia/matching 4.5 (SD 4.7) dementia vs 3.5 (SD 6.1) controls, p = 0.04). Older adults with diabetes with incident dementia have higher rates of acute and post-acute care use, but decreasing outpatient use over time, primarily due to a decrease in specialty visits.

Body mass index as the main predictor for length of stay in COVID-19 patients with mild and moderate symptoms: a cross-sectional study in COVID-19 emergency hospital in Indonesia

Introduction: COVID-19 emerged as a novel global health crisis. While it has since been downgraded from its status as a public health emergency of international concern, the virus persists as a global health challenge. This study was aimed to analyze the predictors of LoS in COVID-19 patients based on nutritional status and patient characteristics data. Methods: Participants of this study were the COVID-19 patients with mild to moderate symptoms who registered in COVID-19 Emergency Hospital, East Java, Indonesia. This study involved 2850 patients extracted from medical records for further analysis. Body mass index (BMI) was generated following the standard formula measured on the first day of hospitalization. LoS was determined by the number of days of hospitalization. The Chi-square automatic interaction detection (CHAID) algorithm was employed for model building. Results: Most participants were overweight (34.6%) and obese (17.2%). Only a few participants were hospitalized with comorbidities such as hypertension (11.6%) and diabetes mellitus (4.1%). The predictive model of LoS indicated that BMI was the main predictor of COVID-19 LoS, with higher BMI showed to prolong the LoS of mild to moderate symptoms patients. Other than BMI, gender and symptoms were also indicated as COVID-19 LoS predictors. Conclusions: Nutritional status is one of the predictors of LoS in COVID-19 patients. Having higher BMI tends to prolong the LoS, especially in male and having fever. LOS was also seen among those with lower BMI less than 18.5, in patients who had cold and flu.

Evaluating prognostic indicators for in-hospital mortality in Fournier's gangrene: a 7-year study in a tertiary hospital.

Fournier's Gangrene Scoring Index (FGSI), Simplified FGSI (SFGSI), Uludag FGSI (UFGSI), Laboratory Risk Indicator for Necrotizing (LRINEC), Neutrophil-Lymphocyte ratio (NLR), and Platelet-lymphocyte ratio (PLR) have been devised to assess the risk of mortality in Fournier's Gangrene (FG) patients. However, the effectiveness of these indicators in predicting mortality at the time of admission remains uncertain. The aim of this study is to assess the prognostic efficacy of FG's various indicators on in-hospital mortality. This study analyzed 123 patients from Dr. Soetomo General Hospital's emergency department in Indonesia from 2014 to 2020. Data included demographics, wound cultures, and parameters like FGSI, UFGSI, SFGSI, NLR, PLR, and LRINEC. In-hospital mortality status was also recorded. The data was subjected to comparative, sensitivity, specificity and regression analyses. In our study of 123 patients, the median age was 52, with a mortality rate of 17.9%. The majority of patients were male (91.1%) and the most common location was scrotal (54.5%). Non-survivors had a shorter median stay (6.5 days) compared to survivors (14 days). Diabetes was the most prevalent comorbidity (61.8%). The highest sensitivity and specificity were found in FGSI and UFGSI indicators. Multivariate logistic regression identified LoS and FGSI as independent predictors of mortality. FGSI and UFGSI, upon admission, demonstrated the highest sensitivity and specificity, with hospital stay duration and FGSI as key mortality determinants.

Craniofacial Trauma of Equestrian Origin.

Horse riding is a popular yet dangerous sport, often resulting in facial traumas due to unpredictable horse reactions or falls. This retrospective study examines 20 patients. The aim of the study is to analyze maxillofacial traumas of equine origin and discuss prevention strategies. Conducted from 2004 to 2021 at our university hospital's emergency department in France, inclusion criteria encompassed patients with maxillofacial trauma admitted to the emergency department and referred to ENT and/or dentistry post-horse-related accidents. Patients were identified from the Health Data warehouse. While 35 medical files were accessed, 15 did not meet inclusion criteria. Analysis of patient parameters, including age, sex, injury date, circumstances, injury type, management, helmet usage, operative interventions, and potential sequelae, revealed a predominantly female population (16 versus 4) under 48 years old. Traumas were most prevalent in summer (80%) and frequently involved riders on foot (60%). Seventy percent of patients sustained at least 1 facial fracture, with helmet use documented in only 1 case. In conclusion, horse riding can lead to various traumas, often necessitating surgical intervention. Preventive measures such as protective helmets, even for nonmounted riders, are crucial as the literature highlights many injuries occurring due to helmet omission.

Meteoropathy: myth or reality? Assessment of the relationship between cardiovascular diseases and weather conditions according to data from a Moscow hospital

Many patients and some doctors associate the worsening of cardiovascular diseases with meteoropathy (changes in atmospheric pressure and air temperature). Opinion about lack of weather influence on the increase in overall morbidity and the lack of related research data indicate the need to study the relationship between cardiovascular diseases and meteorological conditions.Aim. To assess the prevalence of hospitalizations with symptomatic increases in blood pressure (BP), atrial fibrillation (AF), and decompensated heart failure (HF) in a Moscow hospital depending on meteorological conditions.Material and methods. This retrospective analysis of the number of emergency hospitalizations of patients with symptomatic increases in blood pressure, AF, and decompensated HF in Moscow City Clinical Hospital № 24 was carried out in the period from October 1, 2018 to September 30, 2019. Information from the website www.weather.com was used as a source of meteorological data. The following indicators were assessed daily: daytime air temperature (t), nighttime air temperature, maximum diurnal air temperature variation, atmospheric pressure, maximum diurnal atmospheric pressure variation, amount of precipitation. To assess statistical significance, the Mann-Whitney and Kruskal-Wallis tests were used. A correlation analysis was carried out, and a prognostic model was created using multiple linear regression.Results. During the period from October 1, 2018 to September 30, 2019, 4354 patients were hospitalized at City Clinical Hospital № 24 with symptomatic BP increase and/or AF and/or decompensated HF. The highest number of hospitalizations occurred in November, December and January. The median number of admissions per day was 12 patients. When comparing the mean number of patients admitted to the hospital per day, depending on day- and nighttime air temperature, following statistically significant differences were obtained (p&lt;0,001): with day- and nighttime air temperature ≥0о C, the number of admissions was less compared to sub-zero temperatures. Significant inverse correlations were established between the number of patients hospitalized with symptomatic BP increase, AF and HF per day, with air temperature at night (correlation coefficient r=-0,339; p&lt;0,001), air t during the day (r=-0,316; p&lt;0,001), temperature difference over 48 hours (r=-0,205; p&lt;0,001); direct correlations with atmospheric pressure (r=0,106; p=0,044) and its changes (r=0,115; p=0,028) were identified. All identified relationships were of moderate strength. According to prognostic model, only nighttime air temperature turned out to be a significant indicator associated with the hospitalization rate per day. With a decrease in air temperature at night for every 7,5о C &lt;0, one more patient is expected to be hospitalized with a symptomatic BP increase, decompensated HF, or paroxysmal AF.Conclusion. Negative air temperature in a metropolis is associated with an increase in hospitalizations for symptomatic BP increase, AF or decompensated HF. Atmospheric pressure and precipitation do not affect these conditions.

“The reasons you believe …”: An exploratory study of text driven evidence gathering and prediction from first responder records justifying state authorised intervention for mental health episodes

Objective First responders’ mandatory reports of mental health episodes requiring emergency hospital care contain rich information about patients and their needs. In Queensland (Australia) much of the information contained in Emergency Examination Authorities (EEAs) remains unused. We propose and demonstrate a methodology to extract and translate vital information embedded in reports like EEAs and to use it to investigate the extreme propensity of incidence of serious mental health episodes.Methods The proposed method integrates clinical, demographic, spatial and free text information into a single data collection. The data is subjected to exploratory analysis for spatial pattern recognition leading to an observational epidemiology model for the association of maximum spatial recurrence of EEA episodes.Results Sentiment analysis revealed that among EEA presentations hospital and health service (HHS) region #4 had the lowest proportion of positive sentiments (18 %) compared to 33 % for HHS region #1 pointing to spatial differentiation of sentiments immanent in mandated free text which required more detailed analysis.At the postcode geographical level, we found that variation in maximum spatial recurrence of EEAs was significantly positively associated with spatial range of sentiments (0.29, p < 0.001) and the postcode-referenced sex ratio (0.45, p = 0.01). The volatility of sentiments significantly correlated with extremes of recurrence of EEA episodes. The predicted (probabilistic) incidence rate when mapped reflected this correlation.Conclusions The paper demonstrates the efficacy of integrating, machine extracted, human sentiments (as potential surrogates) with conventional exposure variables for evidence-based methods for mental health spatial epidemiology.Such insights from informatics-driven epidemiological observations may inform the strategic allocation of health system resources to address the highest levels of need and to improve the standard of care for mental patients while also enhancing their safe and humane treatment and management.

Clinical-Pathological Features of Thyroid Neoplasms in Young Patients Diagnosed in a Single Center.

Background and objectives: The aim of this study was to evaluate the clinical-pathological profile in young patients with thyroid cancer. Materials and methods: We realized a retrospective study on patients with thyroid neoplasms who underwent surgery at the "Pius Brinzeu" County Clinical Emergency Hospital in Timisoara, Romania. A comparative analysis of some parameters between two groups, young patients (<45 years) versus patients ≥45 years, was performed. Results: A total of 211 patients met the study inclusion criteria, mostly females (86.26%) with a female/male ratio of 6.81:1. In patients <45 years old (25.64%), papillary thyroid carcinoma was identified in 51.85% of cases; in 53.85% of cases, the tumor was >1 cm; 13.46% had extrathyroidal extension (p = 0.0430); 21.15% capsule invasion (p = 0.1756); 23.08% lympho-vascular invasion (p = 0.0048); and 13.46% of cases locoregional nodal invasion (p = 0.0092). Conclusions: Thyroid cancer in young people was associated with chronic lymphocytic thyroiditis and tumor progression parameters, identifying more cases of extrathyroidal extension, locoregional nodal invasion, lympho-vascular invasion and perineural invasion in young patients compared to older ones. For a better understanding of this pathology and to improve diagnosis and therapeutic management, more studies are needed for these patients.

Long-term prescribed opioid use after hospitalization or emergency department presentation among opioid naïve adults (2014-2020)-A population-based descriptive cohort study.

The aim of this work is to describe opioid initiation and long-term use after emergency department (ED) visits or hospitalizations in New South Wales, Australia, by patient, admission and clinical characteristics. This is a population-based cohort study, including all hospitalizations and ED visits between 2014 and 2020, linked to medicine dispensings, deaths and cancer registrations (Medicines Intelligence Data Platform), among adults with no opioid dispensings in the previous year. Outcome measures were opioid initiations (dispensed within 7days of discharge) and long-term use (90 days of continuous exposure, 90-270 days after initiation). The cohort included 16 153 096 admissions by 4.2 million opioid-naïve adults; 39.0% were ED presentations without hospital admission, 16.8% hospital admissions via ED and 44.2% direct hospital admissions. Opioids were initiated post-discharge for 6.2% of ED, 8.3% of hospital via ED and 10.0% of direct hospital admissions; of these 1.0%, 2.5% and 0.5% progressed to long-term opioid use, respectively. Initiation was lowest in obstetric admissions without surgery (1.0%), and highest among trauma admissions (25.4%), obstetric admissions with surgical intervention (19.8%) and non-trauma surgical admissions (12.0%). Long-term use was highest among medical admissions via ED (3.5%), trauma admissions (2.3%) and ED alone (1.0%). From 2014 to 2020, overall opioid initiations decreased 16% from 8.7% to 7.2%, and long-term opioid use decreased 33% from 1.3% to 0.8%. Both opioid initiation and long-term use decreased over time; however, the higher rates of long-term use following trauma, and medical admissions via ED, warrant further surveillance. Strategies supporting appropriate prescribing and access to multidisciplinary pain services will facilitate best practice care.

Design and Analysis of an Islanded Green Energy Station for Highways Emergency Hospitals at Different Locations in Egypt

Design and Analysis of an Islanded Green Energy Station for Highways Emergency Hospitals at Different Locations in Egypt

Detection of SARS-CoV-2 Viral Genome and Viral Nucleocapsid in Various Organs and Systems.

While considerable attention has been devoted to respiratory manifestations, such as pneumonia and acute respiratory distress syndrome (ARDS), emerging evidence underlines the significance of extrapulmonary involvement. In this study, we examined 15 hospitalized patients who succumbed to severe complications following SARS-CoV-2 infection. These patients were admitted to the Sibiu County Clinical Emergency Hospital in Sibiu, Romania, between March and October 2021. All patients were ethnic Romanians. Conducted within a COVID-19-restricted environment and adhering to national safety protocols, autopsies provided a comprehensive understanding of the disease's multisystemic impact. Detailed macroscopic evaluations and histopathological analyses of myocardial, renal, hepatic, splenic, and gastrointestinal tissues were performed. Additionally, reverse transcription-quantitative polymerase chain reaction (rt-qPCR) assays and immunohistochemical staining were employed to detect the viral genome and nucleocapsid within the tissues. Myocardial lesions, including ischemic microstructural changes and inflammatory infiltrates, were prevalent, indicative of COVID-19's cardiac implications, while renal pathology revealed the chronic alterations, acute tubular necrosis, and inflammatory infiltrates most evident. Hepatic examination identified hepatocellular necroinflammatory changes and hepatocytic cytopathy, highlighting the hepatic involvement of SARS-CoV-2 infection. Splenic parenchymal disorganization was prominent, indicating systemic immune dysregulation. Furthermore, gastrointestinal examinations unveiled nonspecific changes. Molecular analyses detected viral genes in various organs, with immunohistochemical assays confirming viral presence predominantly in macrophages and fibroblasts. These findings highlighted the systemic nature of SARS-CoV-2 infection, emphasizing the need for comprehensive clinical management strategies and targeted therapeutic approaches beyond respiratory systems.

An Orthopedic Healthcare Facility Governance Assessed with a New Indicator System.

A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of this research is to develop a new complex tool for evaluating healthcare facility governance as a component of social responsibility, integrated into sustainability. We designed the research to develop the domains of a new reference framework for evaluating healthcare facility governance. The methodology for designing the indicators that make up the new reference framework consists of collecting and processing the most recent and relevant practices regarding the governance of healthcare facilities that have been reported by representative hospitals around the world. We designed eight indicators that are brought together in the healthcare facility governance indicators matrix. They have descriptions and qualitative and quantitative rating scales with values from 0 to 5 that allow the degree of fulfillment to be quantified. The importance of the indicators is evaluated on a specific scale described qualitatively and quantitatively by values from 0 to 5. The values of the degree of achievement-importance couples of the indicators allow the development of improvement measures with priority according to the results revealed by the Eisenhower-type assessment diagram. Validation in practice of the system of indicators at an emergency hospital in an orthopedic profile highlighted the fact that they can be integrated into other national and international reference frameworks implemented in the hospital. The added value of the implementation consists of the facilitation of sustainable development and the orientation of health personnel, patients, and interested parties toward sustainability.

#1370 Frailty prevalence and short-term outcomes among younger end-stage renal disease patients on maintenance hemodialysis

Abstract Background and Aims Frailty is a medical condition of reduced function and health, or a state of heightened risk for catastrophic decline in vitality and function which is evident among end-stage renal disease (ESRD) patients. There has been only limited data regarding its occurrence in the younger age group since most of the published frailty studies involved the elderly as their study population. It is important to identify who among the younger hemodialysis patients are frail, since frailty is related to a higher risk of hospitalization and mortality. This study aims to estimate the prevalence of frailty among younger ESRD patients on maintenance hemodialysis using the Edmonton Frail Scale (EFS) and its association with short-term outcomes: hospital consultations, use of emergency room services, hospitalizations, and mortality. Method A prospective single-center cohort study was conducted. All ESRD patients aged 18-64 years old on maintenance hemodialysis on an outpatient basis were included. Data collection included the patients’ demographic data, underlying diseases, comorbid conditions, body mass index, and recent laboratory results. The EFS was administered during the first month of the study, and patients were then monitored for consultations, use of emergency room services, hospitalizations, and mortality in the succeeding months until the end of the study period. Results Out of 166 ESRD patients, 94 belong to the younger age group and 87 patients were included: 33 (37.9%) were frail, 21 (24.1%) were vulnerable, and 33 (37.9%) were fit. Chronic Glomerulonephritis was the leading cause of ESRD in the younger population, and Diabetic Nephropathy was the primary cause among those categorized as frail. Hypertension was the predominant comorbid condition across all categories. Frail patients had the greatest number of hospital consultations (54%) and had frequent utilization of emergency room services. They also exhibited the highest number of hospitalizations consisting 69% of the total admissions across all categories. All deaths in this study came from the patients categorized as frail. Conclusion Frailty is prevalent among younger ESRD patients on maintenance hemodialysis and is associated with increased risk for hospital consultation, use of emergency room services, hospitalization, and mortality.